Trauma surgeon Marie Crandall, M.D., cares for seriously injured patients at Northwestern Memorial Hospital in Chicago. She operates on patients with life-threatening injuries, such as stab wounds to the heart or ruptured spleens. And she learned all of her surgical skills using methods based on human anatomy, not animal anatomy.
“Animals were not a regular part of surgical training at my residency program,” says Dr. Crandall. “Training consisted almost solely of a graduated apprenticeship model of slowly increasing responsibility for patient care. Advanced Trauma Life Support was taught using animals, but by the time I was a trauma fellow, TraumaMan was being used. As technology has advanced, simulation and other high-retention, risk-reduced methods have become a vital part of surgical education.”
Advanced Trauma Life Support (ATLS) is a two-day course for advanced practitioners to learn the evaluation and stabilization of trauma patients. In the ATLS course Dr. Crandall teaches at Northwestern University, students use patient scenarios with moulage volunteers and human simulators to learn and practice critical procedures.
“The value of the simulators is that they have interchangeable, replaceable parts,” says Dr. Crandall. “One simulator can be used for 15 students to place chest tubes, just by exchanging the chest wall for a fresh one. The anatomic correctness and tissue feel are absolutely unparalleled.”
Dr. Crandall has played a central role in PCRM’s campaign to end the military’s use of animals in trauma training. In August, she flew to San Antonio to demonstrate trauma procedures on a human-patient simulator, SimMan, for a reporter interested in the campaign. She also has attended congressional meetings to urge her members of Congress to support the BEST Practices Act, the bill that would require the military to replace the use of animals with simulators and other human-based methods.
“Many branches of the military are already setting the standard for simulation-based medical education,” says Dr. Crandall. “Other military leaders feel that wound care instruction in the field can only be mimicked by real wounds—thus they use animals and inflict wounds on them.”
Dr. Crandall says that although wounds “can be interesting and dramatic, they are not the target of any immediate intervention other than wound coverage, splinting fractured extremities, and holding pressure to control hemorrhage.”
She explains that these procedures—and other, more important procedures—can be taught using nonanimal methods.
“What is really important is the recognition and management of immediately life-threatening injuries that occur to the airway, lungs, heart, and great vessels,” explains Dr. Crandall. “Trauma training with simulation can optimally teach providers necessary surgical skills and provide both tactile and computer-simulated feedback for learners that can be practiced and repeated, similar to the simulation training utilized by fighter pilots.”
From the critical injuries she sees and treats every day, Dr. Crandall knows how crucial it is that all trauma trainees have a complete, accurate understanding of human anatomy.